Optimizing liver division technique for procuring left lateral segment grafts - new anatomical insights

Left liver lobe (left lateral segment) grafts (LLG) is currently the most commonly used graft to transplant children (2/3 of cases currently in Europe); it is prepared by liver division (DL) in both living (LD) and deceased donors (DD) settings. Technically speaking, classical DL is through the parenchyma of segment IV - dividing the main left glissonean pedicle left to the main biliary confluence (trans-hilar (TH) approach): historically, this technique was introduced by Bismuth and Pichlmayr in 1988 in DD setting, and applied one year later for the first successful living donor transplantations by Strong (Figure 1).